What are the latest COVID-19 drug guidelines?

The KSID, updated instructions for use that reflect the latest research

Withholding core drugs such as Interleukin, Kaletra, and Chloroquine

As COVID-19 pandemic has passed a year, the guidelines for drug use are being updated a lot.

 

As the evidence was accumulated, the differences in the guidelines for use by each country decreased, and detailed recommendations for practical use were derived with recommendations for use and refraining from various cases even with the same drug.

 

Based on the latest academic research, the KSID (The Korean Society of Infectious Diseases) also presented a guideline for drug treatment for COVID-19 infection on the 31st.

 

Based on this, guidelines for drug use and changes in each case were summarized.

 

Remdesivir, approved in Korea in July, has detailed use cases for each patient's condition.

 

The example applied when oxygen therapy is required in patients hospitalized with COVID-19 is different.

 

First of all, Remdesivir can be used (level of evidence: moderate, grade of recommendation: B) for patients with COVID-19 who require oxygen therapy but do not need a ventilator or ECMO treatment, the KSID judged.

 

If this is not the case, the recommendation for administration of Remdesivir was withheld (level of evidence: moderate, grade of recommendation: I).

 

Efficacy and safety of Steroid were also summarized in the latest research.

 

In the early days of COVID-19 epidemic, controversy about the suppression of the immune system and the growth of the virus was raised by steroid administration, but recently, it is being placed on the effectiveness in severe patients.

 

The KSID recommended the administration of Steroids to patients with severe or severe COVID-19 by severity (level of evidence: moderate, grade of recommendation: A).

 

As a clinical consideration for Steroids, Dexamethasone 6mg per day is administered for 7-10 days, and other steroids such as Hydrocortisone 150-200mg, Prednisone 40mg, Methylprednisolone 32mg can be substituted.

 

Steroid administration was not recommended for non-severe corona19 patients (level of evidence: moderate, grade of recommendation: C).

 

Interleukin inhibitors that control inflammation-inducing factors are also classified according to their components and patient severity.

 

Interleukin-6 (IL-6) inhibitors include Tocilizumab and Sarilumab.

 

Interleukin-6 inhibitors can be used within the scope of clinical trials in patients with severe COVID-19 (level of evidence: moderate, grade of recommendation: B), but not recommended for patients with mild COVID-19 (level of evidence: moderate, grade of recommendation: C).

 

Recommendations for the administration of Interleukin-1 (IL-1) inhibitors to COVID-19 patients have been withheld (level of evidence: low, grade of recommendation: I).

 

Plasma treatment, which caused controversy over the effectiveness of treatment, was also put on hold.

 

Plasma therapy is a method of using the immunity of a person who is cured after viral infection.

 

It is a method of collecting COVID-19 antibodies present in the plasma of a cure and administering them to other infected people to fight against the virus, but the effectiveness is still controversial worldwide.

 

As the study that presented the effect and the study that showed no effect were sharply mixed, the lack of clinical participants and the poor clinical design of the study were pointed out as the cause.

 

As a result of combining several studies, the KSID decided to withhold the recommendation for recovery plasma treatment for patients with COVID-19 in the blood system fee (level of evidence: low, recommendation grade: I).

 

General intravenous immunoglobulin (IVIG) administration was also not recommended for patients with COVID-19.

 

However, it suggested that the use of immunoglobulins should not be excluded in the treatment of complications (level of evidence: low, grade of recommendation: C).

 

Chloroquine was actually scheduled to be withheld as a COVID-19 treatment.

 

Chloroquine suppresses the maximum effective concentration of the virus by half in laboratory studies, but in actual studies involving SARS and MERS, there has been no high-quality evidence of efficacy.

 

The KSID also concluded that based on the latest studies, it does not recommend either the administration of Hydroxychloroquine alone or in combination with Azithromycin for COVID-19 patients (level of evidence: high, recommendation grade: C).

 

The KSID concluded that it does not recommend AbbVie's antiviral drug Kaletra (Lopinavir/Ritonavir) for COVID-19 patients.

 

The level of evidence is high.

 

In fact, it means that even the use of the drug is ineffective or that statistically significant differences cannot be identified.

 

Administration of other drugs known to have antiviral effects such as Favipiravir, Ribavirin, Umifenovir and Baloxavir marboxil is not recommended except for clinical trials (level of evidence: low, grade of recommendation: C).